Echo research and practice 2018 03 14() pii 10.1530/ERP-17-0074
72 year old man with known systolic & diastolic heart failure presented with congestive cardiac failure symptoms over a period of 6 weeks. Successful resection of left upper lobe lung adenocarcinoma 4 years prior. Poor response to optimal medical therapy and IV diuresis. Repeat echocardiogram elicited rare images (Videos 1, 2 and 3) of a significant invasive pericardial tumour involving myocardium and endocardium (Figure 1). Comparative CT thorax images are also provided (Figure 2a & Figure 2b). The importance of cardiac silhouette evaluation on CXR’s for interval change is highlighted with 6 month retrospective review in this case (Figure 3). A radiographic diagnosis of metastatic adenocarcinoma was made. Given co-morbidities the patient was palliated, after MDT discussion, and died soon after in hospice. Primary pericardial tumours are rare. Most common primary sites for metastatic pericardial tumours are lung, breast and the bone marrow (1). Involvement of pericardium and epicardium occurs in up to 70% of patients, usually by direct invasion, with involvement of myocardium in approximately 30%. Extension to endocardium is rare (2). Significant learning from this case with multi-modality imaging evidence of rare pathology.